Provider Demographics
NPI:1942230537
Name:PARKER, PENNY LEA (NP)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:LEA
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 4TH ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1635
Mailing Address - Country:US
Mailing Address - Phone:510-599-5001
Mailing Address - Fax:
Practice Address - Street 1:2221 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1318
Practice Address - Country:US
Practice Address - Phone:510-599-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283865363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health